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Wayne County Report 0 2019 Maury Regional Medical Center WAYNE COUNTY REPORT- SEPTEMBER 2019

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Page 1: Maury Regional Medical Center WMC CHNA.pdf · USA $57,652 $0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 Wayne Tennessee USA Median household income Median household income

Wayne County Report

0

2019

Maury Regional Medical Center

WAYNE COUNTY REPORT- SEPTEMBER 2019

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Table of Contents

Executive summary……………………………………………………………………….3-4

Introduction…...…………………………………………………………………………3

Summary of Findings………….………………………………………………………3-4

1. Background………………………………………………………………………………5

Definition of Community………………………………………………………………….5

Priority areas for previous CHNA (2016)…………...…………………………………….5

2. Methods……………………………………………………………………...…………6-8

Secondary data….…………………………………………………………………………6

Primary data…….…...……………………….…………………………………………6-7

Identified health issues…………...……...…………………………………………….......7

Data considerations……………..…………………………………………………………8

3. Secondary data findings…...…………………………………………………………9-18

Summary of Care Offered at Wayne Medical Center.…………………………………….9

Demographics…...………………………………………………………………………...9

Socio-economic determinants of health……......…...……………………………….10-14

Median household income…………………………………………………….…10

Poverty……………………………………………………………………….…..11

Unemployment…………………………………………………………….……..12

Education…………………………………………….…………………………..13

Socio-needs index: CHNA 2016…………………………………………..…….14

Socio-economic factors…………………………………………………………………..15

Health outcomes………………………………………………………………………….15

Clinical care……………………………………………………………………………...16

Prescription drug abuse………………………………………………………………17-18

4. Primary data findings…………………………………………………………….19-21

Top 3 issues………………………………………………………………..……………19

Unaddressed needs…………………………………………………….………………..19

Biggest concern…………………………………………………………………………19

Common problems of the county……………………………………………………19-20

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Common pressing themes……………………………………………………………….21

5. Appendix: A & B …………………………………………………………………22-31

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Executive Summary

Introduction

Maury Regional Medical Center (MRMC) is pleased to present the 2019 Community

Health Needs Assessment. The counties selected for this assessment are: Maury, Marshall,

Wayne and Lewis.

The goal of this assessment was to identify the health needs of the above-mentioned

counties and work on partnering with the county health councils to develop an action plan to

address the prioritized needs. Several health disparities, unmet needs of the community, gaps in

addressing the health needs of vulnerable populations and in provision of services have been

identified.

Summary of Findings

Based on the primary data gathered from interviewing the stakeholders in the community

and secondary data gathered from public domain, the following findings are drawn:

Leading indicators of health: (secondary data)

Source: Tennessee Vital Signs, 2019

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The Department selected these 12 metrics based on extensive public engagement. These

metrics are a result of the data available and the projected meaningful outcomes, which taken

together collectively assess the state’s health and prosperity. These are areas of opportunities and

provide a basis for improving the health of the population.

The big four for Tennessee are a reason for at least six out of ten leading causes of death.

These are:

1. Smoking

2. Obesity

3. Physical inactivity

4. Substance abuse

Source: Tennessee Department of Health: State Health Plan; 2018

Top concerns in Wayne County: (primary data from 4 key informants)

Opioid crisis (3) Transportation (2)

These top concerns were identified based on the key informant interviews, where

fourteen stakeholders were specifically asked to mention their opinion of the top 3 problems of

Wayne county. This list emerged based on the most frequently mentioned problems.

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1. Background

This report is an overview of the health needs in the Wayne Medical Center service area. It

helps in better understanding of the health needs thereby guiding the hospital to address

prioritized needs.

Definition of Community

The counties selected from Maury’s service area for the Community Needs Assessment

2019 are: Maury, Marshall, Wayne and Lewis.

Priority areas from previous CHNA: CHNA 2016

1. Exercise, Nutrition, & Weight

2. Mental Health

3. Substance Abuse

4. Access to Health Services

These issues were prioritized based on voting by the population health department and key

staff in the hospital at Maury Regional Medical Center.

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2. Methods: (Sources for 2019 CHNA)

Secondary data collection

The secondary data source was collected using 8 publicly available sources. This data

comprised of the following:

The secondary data was used to draw comparisons between the performance of

Tennessee counties and then compared with the state level and national level data.

Refer Appendix A for the list of secondary data sources used.

Primary data collection

The primary data was gathered by interviewing four key informants from the community.

An interview questionnaire comprising of twelve questions as a template and a mandatory

activity was used to gather the data. These key partners are:

County specific

data

Tennessee state data

Trends

US data

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Table 1: Wayne County Key Informants

KEY INFORMANTS

HEALTH DEPARTMENT

JOINT ECONOMIC & COMMUNITY DEVELOPMENT BOARD

MEDICAL CENTER

The key informants belong to various government public health departments, are members of

medically underserved, low-income or minority population.

Refer Appendix B for the detailed list of primary data sources and scoring methodology

for the questionnaire and activity.

Identified Health Issues

Top 3 issues: (according to primary data- 4 KI)

1. Transportation (2)

2. Opioid crisis (2)

The four key informants during their interviews were asked to cite the top three issues of the

county and above mentioned were the answers that were most frequent.

Forced ranking:

The forced ranking was done as an activity-based exercise during the key informant

interviews. The sum of the ranking scores was used as a metric to determine the number one

priority and the least value has been considered as top priority. This led to the following priority

areas:

Uninsured rate

Opioid crisis

Exercise, nutrition & weight

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Data considerations

The primary data that was gathered had certain limitations. Efforts were made to select

the key informants from all possible relevant sectors of the community. Based on their

availability during the assessment period, four of the informants took part.

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3. Secondary data findings

Summary of care offered at Wayne Medical Center

Wayne Medical Center (WMC) has been offering quality care to the residents of Waynesboro,

Collinwood, Clifton, and the surrounding area for over 50 years. The hospital has approximately

180 employees and is licensed for 80 beds. It is accredited by The Joint Commission. The

services available at WMC include:

Billing Information

Diagnostic Imaging

Emergency Department

Emergency Medical Services

Endoscopy

Infusion Therapy

Laboratory Services

Physical Therapy

Physician Specialist Clinic

Respiratory Care Services

Sleep Center

Surgical Services

Swing Beds (Skilled Nursing Beds)

Wellness Screenings

Demographics

Population: 16,558 <18

YOA:

17% 65+

YOA:

19.5% % Rural: 100.00%

Unemployment: 8.4% %

Females:

44.80% %

Males:

55.20% Graduation

Rate:

79%

Households: 5,860 MHI: $34,299

Source: Unites States Census Bureau 2017-2018

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Socio-economic factors (based on the Unites States Census Bureau 2017 data)

1. Income

The median household income in Wayne Medical Center’s service area was relatively low

when compared to the State ($48,708).

Median Household Income by County-2017

Giles $43,925

Lawrence $41,522

Lewis $37,092

Marshall $46,837

Maury $52,080

Wayne $34,299

USA $57,652

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

Wayne Tennessee USA

Median household income

Median household income

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2. Poverty

21% of the population suffers from poverty which is higher than the state value of 15%.

Poverty by County-2017

Giles 15.2%

Lawrence 15.6%

Lewis 17.5%

Marshall 11.7%

Maury 10.2%

Wayne 21%

USA 12.3%

0%

5%

10%

15%

20%

25%

Wayne Tennessee USA

Poverty

Poverty

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3. Unemployment

According to the 2017 U.S. Census Bureau data, the WMC’s service area unemployment

rate (8.4%) was higher than the state of Tennessee (6.5%).

Unemployment Rate by County-2017

Giles 5.9%

Lawrence 8.8%

Lewis 4%

Marshall 6.5%

Maury 6.2%

Wayne 8.4%

USA 6.6%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

Wayne Tennessee USA

Unemployment

Unemployment

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4. Education

The residents with a bachelor’s degree or higher are 11.11% which is far lower than

the state value of 26.1%. Whereas the high school graduates are 79% which is lesser

than the state value of 86.5%.

Educational Attainment by County-2017

High School Degree

or Higher*

Bachelor’s Degree

or Higher*

Giles 84.6% 14.8%

Lawrence 80.8% 12.2%

Lewis 83.2% 12.0%

Marshall 85.3% 13.4%

Maury 89.4% 20.7%

Wayne 79.0% 11.11%

USA 87.3% 30.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Wayne Tennessee USA

High school degree or higher

Bachelor's degree or higher

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5. Socio-needs index (Source: Community Health Needs Assessment 2016)

The SocioNeeds Index® developed by the Healthy Communities Institute, incorporates

estimates for six social and economic determinants of health — income, poverty,

occupation, unemployment, educational attainment, and linguistic barriers. These are

associated with poor health outcomes that include preventable hospitalizations and

premature deaths. The zip code with the highest level of socioeconomic need is 38471.

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Where does Wayne County stand when compared to the TN counties and the nation?

Social and economic factors:

The high school graduation in Wayne county is better than most of the counties in the state on

Tennessee and above the US value. The income inequality is average within the state and the

nation. Whereas, the social associations are poor in the state and when compared to the nation.

Health outcomes:

The premature deaths value is good when compared to the state counties but poor in terms of the

national value. Wayne’s poor/fair health is worse within the state and nationally. Poor physical

health days and mental health days are average within the state and far away from the US values.

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Clinical care:

In terms of clinical care, Wayne County has worse care in terms of the uninsured, preventable

hospital stays and diabetic monitoring. There is a dearth of mental health providers and dentists.

This holds true within the state and nationally. Primary care physicians are less in ratio when

compared to the population within the state and in terms of US value.

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Prescription Drug Abuse

Despite:

• good medical practice (reductions in the number of opioids prescribed and

dispensed)

• fewer doctor shoppers, and

• increased utilization of the CSMD

Drug overdose deaths increased by 12% from 2015-2016.

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Refer Appendix A for Secondary data sources.

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4. Primary Data Findings:

Different themes that emerged from interviewing the 4 key informants within Wayne

County.

i. The identified top 3 issues are as follows:

1. Transportation (2)

2. Opioid crisis (2)

These issues are the most concerning problems for the key informants based on their area of

expertise and/or experience.

ii. The issues that are unaddressed according to the key informants are:

Behavioral health (2) Physical health (2) Education (2)

Most of the key informants stated a lack of availability of resources required to address these

concerns.

iii. The biggest concern or issue for the key informants are identified as below:

Child abuse (1)

Untrackable

follow-ups (1)

Heart failure (1)

Fire fighters (1) Patient

engagement (1)

The key informants lose sleep over these issues. Child abuse, Heart failure, Untrackable

follow-ups, Fire fighters and Patient engagement were the biggest concerns.

iv. The key informants stated these as the most common problems in Wayne County:

Education (3) Opioid crisis (2)

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v. As a part of the last segment of the interview process, the key informants were given

an activity-based task, which would compel them to rank the selected issues. As a

result of this, the following ranking emerged:

(1- highest priority; 5-lowest priority)

Number 1 priority: (based on forced ranking)

Uninsured rate

Substance Abuse

Exercise, nutrition & weight

Please refer to Appendix B for the scoring criteria of the forced ranking.

Quality of Life Health Topic Health Topic

Uninsured rate 1 Substance abuse 1 Exercise, nutrition and weight 1

Transportation 2 Mental health and mental disorders 2 Maternal, fetal and infant health 2

Economy 3 Access to health services 3 Heart disease and stroke 3

Educational attainment 4 Diabetes 4 Cancer 4

Per capita income 4 Teen births 5 Prevention and safety 4

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Common pressing themes across regions: (CHNA 2019)

Maury

Marshall Wayne Lewis

Mental health

(15)

Opioid crisis

(9)

Education

(4)

Opioid crisis

(9)

Opioid crisis

(13)

Mental health

(6)

Opioid crisis

(5)

Patient engagement

(2)

Diabetes

(9)

Education

(3)

Obesity

(2)

Exercise, food &

nutrition

(2)

Obesity

(5)

Behavioral health

(2)

Exercise, food &

nutrition

(2)

Internet safety

(2)

Hypertension

(8)

Heart disease

(3)

Transportation

(3)

Vaping

(2)

Exercise, food &

nutrition

(10)

Lack of economic

opportunities

(4)

Access to health care

(2)

Family disruptions

(2)

Access to health care

(8)

Access to health care

(3)

Heart disease

(2)

Refer Appendix B for the common pressing themes under the primary data collection

methods.

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5. Table of contents

Appendix A: Secondary data

Appendix B: Primary data

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Appendix A: Secondary Data

A total of 9 data sources were used to gather the secondary data.

The determinants of health data were taken from the U.S. Census Bureau 2017-2018. The

values for six counties; Maury, Marshall, Lewis, Wayne, Lawrence and Giles were used for a

county level comparison. The Marshall County performance was then compared to the state and

national average.

The social and economic factors, health outcomes and clinical care data of the following

counties: Wayne, Marshall, Hickman, Lewis, Giles, Lincoln, Maury, Perry and Lawrence; along

with the U.S. average was taken from the 2016 Tennessee Department of Health Drive Your

County to the Top Ten.

The Tennessee Department of Health, Office of informatics and Analytics; Controlled

Substance Monitoring Database and the Death Statistical File were used for the prescription drug

abuse data.

Secondary data sources:

Community Health Needs Assessment Chittenden and Grand Isle Counties, Vermont.

Drug Investigation Division

National Institute on Drug Abuse (NIDA).

State Health Plan

Drive Your County to the Top Ten

Maury Regional Medical Center Community Health Needs Assessment.

Prescription Drug Abuse and Pain Management Clinics

U.S. Census Bureau QuickFacts: United States.

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Appendix B: Primary data

To gather the required information from the key informants, an interview guide

consisting of twelve questions was used as a template. The following questions were asked:

Interview questions

1. Which organization are you representing?

2. What category does this organization belong to:

Education Government

Health Private

Advocacy Not for profit

Faith-based For profit

Social service

3. Do you work for one or more of the below mentioned counties?

Maury Lewis

Marshall Lawrence

Wayne Giles

4. What are the most common health problems in this county?

5. What are some challenges encountered while addressing the health needs?

6. What inhibits the patients from adopting some behaviors?

7. What are some challenges that you face while helping the patients/community that you

serve?

8. What are the top 3 health issues faced by this community/county?

9. How can hospitals improve health services and quality of life of people here?

10. What do you consider are the unaddressed needs of the community?

11. In your opinion, why are these needs not being addressed?

12. What are the current resources available to address the health concerns and how can we

do better?

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At the end of the interview, an activity-based task was given to the key informants, which

was aimed at deriving a forced ranking. Three buckets were created aiming at economic issues,

health issues and access.

If you had $100, how would you spend on each category? (Options: 0, 10, 15, 25 & 50)

Per capita income

Uninsured rate

Transportation

Economy

Educational attainment

Diabetes

Substance Abuse

Teen births

Mental Health & Mental Disorders

Access to Health Services

Prevention & Safety

Cancer

Maternal, Fetal & Infant Health

Heart Disease & Stroke

Exercise, Nutrition, & Weight

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The limitation of this activity was that not all key informants used the five denominations

mentioned and repeated the denominations in the same bucket. To come at a conclusion, we

ranked the denominations as follows:

Denomination Rank

0 5

10 4

15 3

25 2

50 1

A sum of the ranks for each category gave us a score, which was then used to determine

the final rank. Lowest score implies the highest ranking, or the number one priority and highest

score implies the lowest ranking or the least priority.

Categories Forced ranking Score

Per capita income 4 13

Uninsured rate 1 9

Transportation 2 10

Economy 3 11

Educational attainment 4 13

Diabetes 4 13

Substance abuse 1 4

Teen births 5 18

Mental health and mental disorders 2 8

Access to health services 3 10

Prevention and safety 4 13

Cancer 4 13

Maternal, fetal and infant health 2 9

Heart disease and stroke 3 11

Exercise, nutrition and weight 1 7

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For the interview questions, the challenge was that not all twelve questions were asked

during the interview, as they were only an interview guide. The four key informants did not

always give answers to all the questions that were asked. Based on the availability of answers

provided, the burning questions that were answered and were most frequent, were considered for

the assessment. The number mentioned next to each category represents the number of times it

was mentioned during that question.

i. Top 3 concerns

Concerns Frequency

Poverty 1

Access to healthcare 1

Transportation 2

Exercise, nutrition and weight 1

Dental needs 1

Obesity 1

Opioid crisis 2

Cancer 1

Summary of top 3 concerns:

This list emerged based on the most frequently mentioned problems. The categories with

only one vote/answer were eliminated and the rest were considered.

Transportation (2) Opioid Crisis

(2)

ii. The unaddressed needs of the county:

The following responses were listed when the unaddressed needs of the county were

mentioned by the key informants. These were the needs that were not getting enough attention.

Unaddressed needs Frequency

Behavioral health 1

Physical health 1

Education 1

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The issues that were considered were the once with more than one frequency in

responses. These are mentioned below:

Behavioral health (2) Physical health (2) Education (2)

iii. The biggest concern

The following issues were considered as the biggest concerns according to the key

informants.

Biggest concern Frequency

Child abuse 1

Untrackable follow-ups 1

Heart failure 1

Fire fighters 1

Patient engagement 1

iv. The common problems of the county:

The following were mentioned as the common problems of the county:

Common problems Frequency

Transportation 1

Education 3

Access to providers 1

Opioid crisis 2

Unemployment 1

Exercise, food & nutrition 1

Diabetes 1

Heart disease 1

Obesity 1

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The top 2 problems were considered as the common problems of the county. These are as

follows:

Opioid crisis (2) Education (3)

v. The common pressing themes of the 4 counties were derived based on the frequency

of occurrence of issues under the 4 categories: top 3 issues, unaddressed needs,

biggest concern and common problems of the county. The overall top 7 issues for

each county was taken into consideration (on page 30).

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The common pressing themes:

Maury

Marshall Wayne Lewis

Mental health

(15)

Opioid crisis

(9)

Education

(4)

Opioid crisis

(9)

Opioid crisis

(13)

Mental health

(6)

Opioid crisis

(5)

Patient engagement

(2)

Diabetes

(9)

Education

(3)

Obesity

(2)

Exercise, food &

nutrition

(4)

Obesity

(5)

Behavioral health

(2)

Exercise, food &

nutrition

(2)

Internet safety

(2)

Hypertension

(8)

Heart disease

(3)

Transportation

(3)

Vaping

(2)

Exercise, food &

nutrition

(10)

Lack of economic

opportunities

(4)

Access to health care

(2)

Family disruptions

(2)

Access to health care

(8)

Access to health care

(3)

Heart disease

(2)

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Primary data participants

Organization represented Name

Wayne Health Department Devin Toms

Wayne Health Department Erica Barnett

Joint Economic & Community Development Board Rena Purdy

Wayne Medical Center Dean Steagall

Maury Regional Medical Center

Attention: Mark Kirschbaum

CHNA Feedback

1224 Trotwood Avenue

Columbia, Tennessee 38401

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References

(2016). Community Health Needs Assessment Chittenden and Grand Isle Counties, Vermont.

Retrieved from https://www.uvmhealth.org/medcenter/Documents/About-Us/CHNA.pdf

(n.d.). Drug Investigation Division. Retrieved from https://www.tn.gov/tbi/divisions/drug-

investigation-division.html

(n.d.). National Institute on Drug Abuse (NIDA). Retrieved from https://www.drugabuse.gov/

(n.d.). State Health Plan. Retrieved from

https://www.tn.gov/content/dam/tn/hsda/documents/State Health Plan-2017 2018.pdf

2016 Drive Your County to the Top Ten. Nashville: Tennessee Department of Health. Prepared

by the Division of Administrative Services. May 2016.

(2016, November). Wayne Medical Center Community Health Needs Assessment. Retrieved

from https://www.mauryregional.com/media/file/MRMC CHNA 2016.pdf

(2018, January 31). Prescription Drug Abuse and Pain Management Clinics - tn.gov. Retrieved

from https://www.tn.gov/content/dam/tn/health/documents/Prescription-Drug-Abuse-

Report-2018.pdf

(2018, July 1). U.S. Census Bureau QuickFacts: United States. Retrieved from

https://www.census.gov/quickfacts/fact/table/US/PST045218

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